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Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial.

ABSTRACT: INTRODUCTION:Virtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of the activation and other patient empowerment measures in patients with ischaemic heart disease (IHD). METHODS AND ANALYSIS:A pragmatic randomised controlled trial will be performed in Catalonia, Madrid and Canary Islands, Spain. Two hundred and fifty patients with a recent diagnosis of IHD attending the participating centres will be selected and randomised to the intervention or control group. The intervention group will be offered participation for 12 months in a VCoP based on a gamified web 2.0 platform where there is interaction with other patients and a multidisciplinary professional team. Intervention and control groups will receive usual care. The primary outcome will be measured with the Patient Activation Measure questionnaire at baseline, 6, 12 and 18 months. Secondary outcomes will include: clinical variables; knowledge (Questionnaire of Cardiovascular Risk Factors), attitudes (Self-efficacy Managing Chronic Disease Scale), adherence to the Mediterranean diet (Mediterranean Diet Questionnaire), level of physical activity (International Physical Activity Questionnaire), depression (Patient Health Questionnaire), anxiety (Hospital Anxiety Scale-A), medication adherence (Adherence to Refill Medication Scale), quality of life (EQ-5D-5L) and health resources use. Data will be collected from self-reported questionnaires and electronic medical records. ETHICS AND DISSEMINATION:The trial was approved by Clinical Research Ethics Committee of Gregorio Marañón University Hospital in Madrid, Nuestra Señora de Candelaria University Hospital in Santa Cruz de Tenerife and IDIAP Jordi Gol in Barcelona. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local/international conferences. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov Registry (NCT03959631). Pre-results.

SUBMITTER: Gonzalez-Gonzalez AI

PROVIDER: S-EPMC7552830 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial.

González-González Ana Isabel AI González-González Ana Isabel AI Perestelo-Pérez Lilisbeth L Koatz Débora D Ballester Marta M Pacheco-Huergo Valeria V Ramos-García Vanesa V Torres-Castaño Alezandra A Rivero-Santana Amado A Toledo-Chávarri Ana A Valcárcel-Nazco Cristina C Mateos-Rodilla Juana J Obaya-Rebollar Juan Carlos JC García-García Javier J Díaz-Sánchez Santiago S Morales-Cobos Luis L Bosch-Fontcuberta Josep María JM Vallejo-Camazón Nuria N Rodríguez-Almodovar Ana A Del Castillo José Carlos JC Muñoz-Balsa Marcos M Del Rey-Granado Yolanda Y Garrido-Elustondo Sofía S Tello-Bernabé María-Eugenia ME Ramírez-Puerta Ana Belén AB Orrego Carola C

BMJ open 20201012 10

<h4>Introduction</h4>Virtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of ...[more]

PMID: 33046465

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Project description:IntroductionThe virtual multidisciplinary stroke care clinic (VMSCC) is the first nurse-led clinic developed to offer support to community-dwelling stroke survivors and caregivers, and to promote poststroke recovery. This two-arm randomised controlled trial will evaluate its effectiveness on survivors' self-efficacy (SE), survivors' and caregivers' health-related quality of life (HRQoL) and cost-effectiveness on emergency admissions and length of readmission hospital stay.Methods and analysisA consecutive sample of 384 stroke survivor-caregiver dyads will be recruited from four hospitals. An online platform that embraces readily accessible and reliable information will be developed. Participants randomly assigned to the intervention group will receive usual care plus the VMSCC service. The service includes access to a tablet containing 30 videos demonstrating appropriate self-care strategies, communication with a registered nurse monthly through video and telephone calls and regular blood pressure monitoring. Primary outcomes include survivors' SE in self-management and survivors' and caregivers' HRQoL. Secondary outcomes include survivors' performance of self-management behaviours, depression and social participation; and caregivers' coping strategies, satisfaction with caring and depression. Data will be collected at baseline, and at 3 and 6 months after commencing the intervention. Survivors' and caregivers' satisfaction with the service will be assessed at 6-month follow-up. Multivariable regressions and generalised estimating equations model will be conducted. Survivors' emergency admissions and length of hospital stay will be evaluated during the 6-month follow-up period. Cost-effectiveness analysis will be performed on the average total cost incurred.DiscussionThe results will inform stakeholders about incorporating the VMSCC service into current stroke rehabilitation service.Ethics and disseminationThis protocol was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2017.660). All participants will provide written informed consent. Results will be disseminated through scientific publications, and presentations at local and international conferences.Trial registration numberChiCTR1800016101; Pre-results.

Project description:BACKGROUND:Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India. METHODS:An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004-2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An 'exposure analysis' explored whether exposure to CM was associated with FSW's empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model. FINDINGS:The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004-2011). Over a 7-year period (2004-2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary--well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving. CONCLUSIONS:Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.

Project description:BackgroundProfessional isolation is an important factor in low rural health workforce retention.ObjectiveThe aim of this study was to gain insights to inform the development of an implementation plan for a virtual community of practice (VCoP) for general practice (GP) training in regional Australia. The study also aimed to assess the applicability of the findings of an existing framework in developing this plan. This included ascertaining the main drivers of usage, or usefulness, of the VCoP for users and establishing the different priorities between user groups.MethodsA survey study, based on the seven-step health VCoP framework, was conducted with general practice supervisors and registrars-133 usable responses; 40% estimated response rate. Data was analyzed using the t test and the chi-square test for comparisons between groups. Factor analysis and generalized linear regression modeling were used to ascertain factors which may independently predict intention to use the VCoP.ResultsIn establishing a VCoP, facilitation was seen as important. Regarding stakeholders, the GP training provider was an important sponsor. Factor analysis showed a single goal of usefulness. Registrars had a higher intention to use the VCoP (P<.001) and to perceive it as useful (P<.001) than supervisors. Usefulness independently predicted intention to actively use the VCoP (P<.001). Regarding engagement of a broad church of users, registrars were more likely than supervisors to want allied health professional and specialist involvement (P<.001). A supportive environment was deemed important, but most important was the quality of the content. Participants wanted regular feedback about site activity. Regarding technology and community, training can be online, but trust is better built face-to-face. Supervisors were significantly more likely than registrars to perceive that registrars needed help with knowledge (P=.01) and implementation of knowledge (P<.001).ConclusionsImportant factors for a GP training VCoP include the following: facilitation covering administration and expertise, the perceived usefulness of the community, focusing usefulness around knowledge sharing, and overcoming professional isolation with high-quality content. Knowledge needs of different users should be acknowledged and help can be provided online, but trust is better built face-to-face. In conclusion, the findings of the health framework for VCoPs are relevant when developing an implementation plan for a VCoP for GP training. The main driver of success for a GP training VCoP is the perception of its usefulness by participants. Overcoming professional isolation for GP registrars using a VCoP has implications for training and retention of health workers in rural areas.

Dataset Information

Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial.

Publications

Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial.

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